The patient experience section of the quality and outcomes framework of the new GMS contract focuses on two areas, consultation length and patient surveys. It is worth a total of 100 points – 30 points for consultation length and 70 points for patient surveys (Table 1, below).1
|Table 1: Patient experience indicators|
|PE 1 Length of consultation
The length of routine booked appointments with doctors in the practice is not less than 10 minutes. (If the practice routinely sees extras during booked surgeries, then the average booked consultation length should allow for the average number of extras seen in a surgery session. If the extras are seen at the end, then it is not necessary to make the adjustments) For practices with only an open surgery system, the average face-to-face time spent by the GP with the patient is at least 8 minutes
|PE 2 Patient surveys (1)
The practice will have undertaken an approved patient survey each year
|PE 3 Patient surveys (2)
The practice will have undertaken a patient survey each year, have reflected on the results and have 15 proposed changes if appropriate
|PE 4 Patient surveys (3)
The practice will have undertaken a patient survey each year and discussed the results as a team and 15 with either a patient group or a non-executive director of the PCO. Appropriate changes will have been proposed with some evidence that the changes have been enacted
For the average practice of 5891 patients the section is worth £7500 in 2004/5 and £12 000 in 2005/6.
PE 1 Length of consultation
The length of the consultation is important to both doctor and patient.2 How that time is used to help patients feel listened to, understood and helped is also important.2
The aim of the GPC negotiators when negotiating the new contract was to include incentives to provide longer consultations. GPs have repeatedly stated that the quality of care is directly related to the amount of time spent listening to patients, discussing issues with them and explaining treatments and so on. These elements of the consultation cannot be easily measured, but a proxy could be considered to be consultation length.1
The 30 points for this indicator (equivalent to £2250 per average practice of 5891 patients in 2004/5, rising to £3600 in 2005/6) can be claimed if the normal booking interval is 10 minutes or more. For this purpose ‘normal’ has been defined as 75% or more of appointments booked at intervals of 10 minutes or longer.
This would mean that extras at the end of a surgery or emergencies fitted in during a surgery do not amount to more than 25% (unless the extras are also booked at 10-minute intervals).
For practices that run open surgeries instead of appointments systems, the length of the consultation should be at least 8 minutes.
It will be up to these practices to prove that they are achieving the target; staff will need to time the actual length of all consultations over two sample weeks each year. There is no need to do this if open surgeries account for less than 25% of patients seen.
Practices with computerised appointment systems can record the length of consultations automatically if the doctors are aware that the system is being used for this purpose.
Practices that routinely operate booked and open surgeries should report on both.
PE 2 Patient surveys (1)
Patient surveys are worth 70 points in total, equivalent to £5250 for the average practice of 5891 patients in 2004/5 and £8400 in 2005/6. The practice will have fulfilled this criterion if it has carried out an approved survey of patients’ views in the previous year.
At present there are two approved surveys, both of which have been widely used in the NHS:
- GPAQ: the General Practice Assessment Questionnaire, information available at: www.gpaq.info (Figures 1-4, below)
- IPQ: Improving Practice Questionnaire, information available at: www.ex.ac.uk/cfep/ipq.htm
|Figure 1: Page 1 of the General Practice Assessment Questionnaire for use following the consultation|
|Figure 2: Page 2 of the General Practice Assessment Questionnaire for use following the consultation|
|Figure 3: Page 3 of the General Practice Assessment Questionnaire for use following the consultation|
|Figure 4: Page 4 of the General Practice Assessment Questionnaire for use following the consultation|
|© GPAQ is copyright of the National Primary Care Research and Development Centre,University of Manchester and Safran/NEMCH|
The aim is to have at least 50 patient questionnaires returned per doctor.
Both GPAQ and IPQ can be used in the surgery, following the consultation, and GPAQ can also be administered by post. Surveys carried out in the surgery should be conducted on consecutive patients, and for postal surveys enough questionnaires should be sent out to ensure that at least 50 are returned.
PCOs can undertake postal surveys with practices’ consent.
PE 3 Patient surveys (2)
The practice must have undertaken one of the approved surveys described in indicator PE 2. Members of staff must discuss the results and consider whether or not any action is required.
To meet this indicator there is no requirement for the practice to share the results with the PCT, but it should provide an overview of the results and any action that has arisen from the discussions.
PE 4 Patient surveys (3)
The practice must have undertaken an approved survey and discussed the results as a team. The results must then be discussed with a patient group or a non-executive director of the PCO.
A report summarising the meeting and detailing any proposed changes will be required as evidence for verification.
In future years, evidence of change as a result of the patient surveys will need to be demonstrated.
With the help of the resources available to them, most practices should be able to achieve the full 100 points for the patient experience section.
- The New GMS Contract: Investing in General Practice. www.bma.org.uk
- Freeman GK, Horder JP, Howie JG et al. Evolving general practice consultations in Britain: issues of length and context. Br Med J 2002; 324: 880-2. Dr Nigel Watson is a member of the BMA’s GPC, chief executive of the Wessex LMCs, and a GP in Hampshire